Ultraviolet keratitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*History of recent UV exposure - symptoms typically occur 6-12 hrs after exposure (will present late night/early AM) | *History of recent UV exposure - symptoms typically occur 6-12 hrs after exposure (will present late night/early AM) | ||
*Symptoms include bilateral [[eye pain]], foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased visual acuity | *Symptoms include bilateral [[eye pain]], foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased [[vision loss|visual acuity]] | ||
*[[Eye exam]] (including slit lamp) | *[[Eye exam]] (including slit lamp) | ||
**Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn) | **Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn) | ||
**Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic | **Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic | ||
** | **Fluorescein exam - '''Superficial Punctate Keratitis''' - small, pinpoint areas of increased uptake on cornea | ||
*Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs | *Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs | ||
Revision as of 17:17, 24 September 2019
Background
- Also known as photokeratitis, welder's flash, snow blindness
- Prolonged/excessive UV exposure to eyes leads to inflammatory response and subsequent desquamation of corneal epithelium leaving exposed nerve endings of cornea
- May not be initially apparent with latent period (6-12 hours) before onset
Causes
- Lack of proper eye protection
- UV exposure from:
- Natural sources: snow, water, high altitudes (less protective ozone), eclipses
- Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights
Keratoconjunctivitis Types
- Atopic keratoconjunctivitis
- Caustic keratoconjunctivitis
- Secondary to chemical orbital exposure
- Epidemic keratoconjunctivitis
- Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
- Ultraviolet keratitis
- Secondary to UV light exposure
- Keratoconjunctivitis sicca
- Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma
Clinical Features
- History of recent UV exposure - symptoms typically occur 6-12 hrs after exposure (will present late night/early AM)
- Symptoms include bilateral eye pain, foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased visual acuity
- Eye exam (including slit lamp)
- Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn)
- Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic
- Fluorescein exam - Superficial Punctate Keratitis - small, pinpoint areas of increased uptake on cornea
- Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs
Differential Diagnosis
- Other causes of keratoconjunctivitis
- Viral conjunctivitis
- Thygeson's Superficial Punctate Keratitis
- Dry eyes
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
Evaluation
- Generally clinical diagnosis
Management
- Analgesia (very painful condition) - PO NSAIDS, opioids.
- Do not prescribe topical anesthetics (i.e. tetracaine) to be used at home, this can lead to poor corneal healing and corneal melt
- Eye rest (avoid re-exposure)
- Lacrilube (saline eye drops)
- ± Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic)
- ± Cycloplegics
Disposition
- Discharge
- Follow up with primary care provider in 1-2 days to ensure improvement of symptoms
- Generally do not need ophtho follow-up given limited course
- Emphasize proper eye protection with future exposure